SERVICE LINE MARKETING: AN OB CASE STUDY Presented by: Dr. Julie Pokela Market Street Research and Brian O’Dea Newton-Wellesley Hospital

Workshop Objectives To understand the importance of service line marketing for traditional general hospitals. To understand the process of developing a successful service line marketing campaign, using OB as a case study.

Importance of Service Line Marketing Increased competition across a broad range of clinical service lines from: Specialty hospitals Outpatient centers General hospitals with centers of excellence Low patient volumes in traditional general hospitals for patients requiring specific treatments. Advantages of targeting specific service lines in terms of: Economies of scale Acquisition of technologies Physician recruitment Marketing costs Growing market share

Process of Developing a Service Line Marketing Campaign Assessing which service lines to target Current market share and opportunities for growth Profitability Clinical strengths vis a vis the competition Assessing the hospital’s current position in the market among consumers and opportunities for growth Developing and implementing the marketing strategy

Case Study: OB Rationale for targeting OB: The role of obstetrics in a hospital’s overall market position Builds hospital loyalty Profit center The unique marketing opportunities afforded by obstetrics Happy event Planned event

Which Comes First: Choosing the Provider or the Hospital? For most women, the selection of a provider for pre-natal care is more important than the selection of a hospital for delivery.

Primacy of Selecting Provider Over Hospital “[Hospital has] a birthing center . . . that you can deliver and it’s pretty much natural. It looks like a real bedroom. You can deliver in a whirlpool with candles. I’ve witnessed a childbirth like that. Absolutely beautiful. And I just chose—I did not choose that, because I was staying with my doctor that I had.”

Who Selects Providers/Hospitals First? In many markets, there are no demographic differences between women who select providers vs. hospitals first In some markets: Older and more affluent mothers are more likely to select providers first Younger and less affluent mother are more likely to select hospitals first

What Is Important to Women in Selecting Providers? Most women have an ob/gyn they use for routine gynecological care, and stay with that provider when they become pregnant. Did you have an ob/gyn you used for routine care prior to becoming pregnant? Did you stay with that ob/gyn for prenatal care?

Implications The patients a hospital’s ob/gyns are seeing for routine gynecological care represent the majority of the patients the hospital will capture for obstetrics It is important to market a hospital’s ob/gyns for routine gynecological care A hospital’s ob/gyns must have appointments available for new patients for routine care in a timely way

How Do Women Select Ob/Gyns? A great bedside manner is the most important criterion “Any questions that I had they always took me into a room. ‘Let’s talk about it,’ any concerns, and just really coached me a lot, what I will be expecting, what not to worry about, he’s very concerned to make sure that I was eating right for the baby, and he was always one step ahead of me. When I left, I never had to worry about questions, so it was a nice feeling.” Recommendations from family and friends are also important “It’s great that there’s these wonderful ob/gyns at [Hospital] … It’s definitely tempting to tell my sister-in-law, who’s looking for a new ob/gyn. It’s close to home. But unless I talk to a woman that went to one of them, it’s hard. It’s all word of mouth.”

How Do Women Select Ob/Gyns? (cont.) About one-half of women prefer a female ob “Sometimes it was nice to see the woman, when you were just having all these women’s emotional things, and aches and pains, and she’s had three children and…women understand what it feels like.” Location is important, because most women are selecting an ob/gyn for routine gynecological care Availability of appointments is also key

How Do Women Select a Hospital? Provider affiliation is frequently the only criterion, because most women select their provider first Location is key to a segment of the market “I just assumed I would go to [Hospital] because it was the closest hospital.” Most women are willing to bypass the closest hospital Having 24 hour availability of epidurals is highly important in most markets, although many women assume that all hospitals offer this. “That’s why I didn’t go to [Hospital], because they can’t always do [epidurals]. They only have an anesthesia team that’s there during regular business [hours]. That was my number one factor.”

How Do Women Select a Hospital? (cont.) There are some factors that are important for patient satisfaction, but don’t play a major role in hospital selection “High touch” Physical facility Women who are concerned about high-risk births consider “high tech” factors. For most women, this is not a significant criterion. Having a wide range of birthing options is less important and women can be skeptical about being able to use options “I have found that touring hospitals they promise you all of that stuff, and then you get there, and they’re like, ‘Oh, no, you lay in the bed and that’s it.’ I was asking about a water birth because I wanted to get in a tub of some sort. I mean it’s awful, nothing. They were like, ‘You have an IV, you have a catheter, that’s it,’ and when I came on my tour, I was promised all this stuff.” Most women are not aware that there are different levels of nurseries, and don’t want to think about problems with their babies “I don’t think I even thought [about the nursery]. I think, especially the first time around, I was just more concerned about myself.”

Obstetrical Collaboration has Long Gestation Period Case Study: Newton-Wellesley Hospital Obstetrical Collaboration has Long Gestation Period

The Market BIDMC MetroWest Mt. Auburn NEMC St. E’s NWH 10 mi MGH BWH Caritas Norwood NWH BWH Mt. Auburn St. E’s BIDMC MGH NEMC 10 mi

Overview Declining Birth rate Reimbursement not keeping pace Physician challenges Increased competition NWH had capacity BWH over capacity

Better Together? Our market research did show that almost all categories of patients would favorably view a collaboration between BWH and NWH. Could BWH and NWH create an OB/GYN program that addresses health care for women and achieve institutional goals?

Better Together? (cont.) “What impact does the collaboration with BWH have on your perception of NWH’s maternity department?” NWH loyalists NWH/PHS AMC splitters Competing comm hosp loyalists Competing comm hosp/ PHS AMC splitters PHS AMC loyalists Competing AMC loyalists % of total Much more positive Somewhat more positive A “loyalist” prefers a hospital for both routine and specialty care, while a “splitter” prefers the first hospital for routine and the second for specialty. Source: Market Street Study, 2002

Our Two Medical Staffs Were Not So Sure History of competition Culture and Strategy Private practice versus academic medical center Market perception issues Brand issues Financial issues MD practice issues (e.g. site changes, splitting time) Governance issues (e.g. titles) Perception that service was “devalued” High resistance all around!

The (birth) Plan Enhance the program in ways that would benefit NWH Obs and demonstrate a commitment to expanding the scope of care to BWH docs Maternal Fetal Medicine Program Assisted Reproductive Technologies (A.R.T.) Gyn Onc Uro-Gyn Fully integrate both services Joint clinical leadership Quality oversight Geography driven cross-referral

The (birth) Plan (cont.) It was a long and complex project with many competing interests in a multi-sided negotiation. It would ultimately take a year and a half to execute. The biggest single component ended up being migrating the HVMA Wellesley site business to NWH (from the Brigham), and reopening an OB practice at Dedham Medical

The Delivery (cont.) "The response from our patients has been better than our group ever hoped for.  In our first year over 80% made the transition with us from the Brigham to Newton-Wellesley and word of mouth has spread so quickly that we are now getting patients transferring from our other Brigham sites.  Our patients especially appreciate access to Brigham and Women's maternal-fetal medicine specialists while enjoying the newly renovated, state of the art facility with Newton-Wellesley's personalized and family friendly care.“ Lori Wroble, MD Harvard Vanguard Medical Associates

The Delivery (cont.) "The presence of the maternal fetal medicine physicians at Newton-Wellesley enables me to continue caring for my patients during complicated pregnancies while providing them with the best high-risk resources the Boston area has to offer.“ Heidi Angle, MD Newton-Wellesley Obstetrics and Gynecology

The Delivery (cont.) “He collaborated really well with my Ob…we really liked the intimacy and connection with the doctors” Karen Korn Ob Patient

The Delivery 8 new Ob/Gyns practicing at three sites 7 new Nurse Midwives A 14% increase in deliveries 1,700 A.R.T. visits/year 32 Gyn Onc. procedures/year 1,300 M.F.M. “assists”/year

Presenter Contact Information Julie Pokela, Ph.D., President Market Street Research, Inc. 413-584-0465 jpokela@marketstreetresearch.com Brian O’Dea, Director, Marketing and Public Affairs Newton-Wellesley Hospital 617-243-5820 bodea@partners.org